An alternative method of endoscopic retrieval of a proximally migrated biliary plastic stent using a “sphincterotome hooking the stent” technique

 

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Stent migration occurs in about 5 % – 10 % of patients undergoing biliary stenting. The risk of proximal stent migration is higher with benign biliary strictures, stenosis of the lower bile duct, bile duct diameter > 10 mm, duration of stent placement > 1 month, and the use of straight and 10-Fr stents [1]. Devices that have been used for the endoscopic removal of stents are biopsy forceps, grasping forceps, basket catheters, balloon catheters, snares, ultra slim cholangioscopes, and the Soehendra stent retriever [2] [3] [4].

We present the case of a 38-year-old woman who was treated with sphincterotomy and insertion of a 6-cm, 10-Fr, straight, plastic, biliary stent for a postcholecystectomy bile duct leakage. Gastroduodenoscopy 30 days later revealed that the stent was not “in situ,” and removal of the proximally migrated stent was attempted.

Initially, a guidewire was advanced through the lumen of the stent ([Fig. 1]) and then a stone retrieval balloon was used, over the wire, to remove the stent. However, this was unsuccessful because the tip of the balloon catheter could not advance past the proximal end of the stent. A sphincterotome was then used, which was advanced successfully over the wire, to 2 – 3 cm beyond the proximal end of the stent, probably because of its stiffness compared with the balloon. Then, the proximal end of the sphincterotome was bent to form a “hook” on which to catch the stent ([Fig. 2]), and the sphincterotome was pulled back slowly. When the hooked stent appeared through the papilla ([Fig. 3]), the endoscope was pulled back in the stomach, from where the stent was finally retrieved using a grasping forceps ([Video 1]).

We propose the use of this previously unreported, simple, and technically easy method for the endoscopic retrieval of a proximally migrated biliary stent.

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• References

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